One indisputable thing is that billing in the dental practice is essential to the financial status of Dental Practice. However, mistakes are found frequently, especially in the areas of billing, which may result in claim denials, delayed payments and may even land you in compliance trouble. Some of these errors include: Ignoring identifiable errors is detrimental to revenue cycle and practice success.
Over the course of this blog post, we will identify four of the most frequently made mistakes in dental billing and explain how to prevent them.
1. Incorrect or Outdated Coding
The Mistake:
Lack of compliance with the latest CDT codes or utilization of failure to effective CDT codes is one of the most frequent mistakes in dental billing.
Why It Matters:
Insurance companies depend on coding to assess and settle claims. An improper code will lead to the denial of claims or underpayment.
How to Avoid It:
- Be up to date on yearly changes in the CDT code.
- This means that it should be taken as a policy that your staff be trained periodically to acquaint them with the latest codes.
- Install billing software that can update the codes automatically.
2. Failure to Fully Document
The Mistake:
Filing claims that lack backing from radiographs, treatment notes or narratives.
Why It Matters:
Also, insurance companies usually need further explanation of the patient’s need for the treatment. Lack of information in the system and the treatment results in a denied claim.
How to Avoid It:
- It specifies that applicants for claims should first consider the documentations that the insurer demands before making their application.
- In order to make sure all the necessary papers are enclosed, it’s useful to make a list of sheets that need to be attached.
- Establish a checking mechanism in the presentation of the claims.
3. Incorrect Patient Information
The Mistake:
Patient identification information are often entered incorrectly, for instance name, date of birth or insurance identification number are common entries that may cause a claim to be rejected.
Why It Matters:
A single digit can produce a contrasting reaction from the insurance company – either complete rejection or unnecessary moths of waiting.
How to Avoid It:
- He or she forgot to double-check with the patients during registration and entries of their details.
- Teach employees to confirm the credentials given to them by questioning the patient to obtain data off his/her insurance card.
- Record automated alarms for incomplete or inconsistent data.
4. No confirmation of Insurance credibility
The Mistake:
This is under the assumption that a patient’s insurance plan approves the procedure immediately without a pre-authorization check.
Why It Matters:
Inadequate coverage or when the benefits have been fully utilized a patient’s claims may be refused, thus patients end up being billed unexpectedly.
How to Avoid It:
- It is advisable to confirm insurance acceptance before booking some of the sessions.
- Assure patients are fully aware of their out-of-pocket expenditure rates.
- Adopt real-time insurance verification systems.
5. Failing to Meet the Deadline on Claim Submission
The Mistake:
Filing claims after the insurer has made his or her time to do so.
Why It Matters:
Each insurance carrier has a particular schedule within which claims must be submitted. Failure to do so means that the claim will not be paid regardless of the merits of the matter at hand.
How to Avoid It:
- Develop an efficient way of documenting the submission due dates of every insurance company.
- Ensure that you submit the claims right after you are through with the treatment.
- By adopting billing software, the process of making claims should be automated.
6. Failing to Correct Mistakes When Re-submitting Claims
The Mistake:
Filing a new claim after being turned down while not paying attention to why this was done.
Why It Matters:
Using the same claim type without correction may make the process run longer or get frustrating and time wastage.
How to Avoid It:
- Check the explanation of Benefits (EOB) to identify the reason of the denial.
- Never error your claim and if there is space to do so you should make the corrections before resubmitting the claim.
- Document submission from the insurer and where necessary, any resubmission to the insurer.
7. Overcoding or Upcoding
The Mistake:
Upcoding, or where the provider charges for a higher-paying code than the service that was provided, and overcoding, or charging for many codes that should be bundled together.
Why It Matters:
Such practices can result in problems of noncompliance, receival of audit, and such other penalties as are considered appropriate by the Governing Council.
How to Avoid It:
- prevent distortion of procedures that are being carried out.
- Educate personnel so that they learn the right way to code.
- Every now and then, undertake a check on the correctness of claims.
8. Ignoring Secondary Insurance
The Mistake:
Not billing a patient’s second insurer after the first insurance carrier has paid the claim.
Why It Matters:
Secondary insurance can help pay for balances, which also helps to lower patient costs and improve practice income.
How to Avoid It:
- The patient’s secondary insurance coverage should always be determined.
- Send a claim to the secondary insurer whenever you receive an explanation of the benefits (EOB) from the primary insurer.
9. Allowing Patients to Go for Weeks without Meeting Them
The Mistake:
The major area that was elicited to be a challenge included failure to explain the amount of billing and insurance claims with the patients prior to service delivery.
Why It Matters:
Thus, it can be stated that too when signing and submitting contracts for certain works and services, one can be in for several unpleasant surprises regarding the costs they did not expect, and that would make their customers dissatisfied and often lacking the desire and/or ability to pay for those very works and services.
How to Avoid It:
- Give a full explanation of charges and insurance before the treatment.
- Provide options for the ability to pay in installments of additional credits for those who require it.
- Engage patients and their families in communication to reduce all health complaints.
10. Failure to consider changes in insurance policies
The Mistake:
Lack of updates and review of insurance policies one is advised to take such as knowing new walks in or changes in benefits offered.
Why It Matters:
Inso did not receive objective insurance information, it was ignorant of these frequent changes and dilatory billing practices which may result in denials.
How to Avoid It:
- Show insurance representatives some appreciation.
- One of the team members must be responsible for tracking policy changes.
- Review large risk insurance contracts and insurance policies periodically.
How The Medicator’s Can Help
Contrary to what you might be thinking right now, it is possible for you to take a break and hire someone else to help you with managing all the dental billing mistakes that may tend to occur in your workplace. Medicators also focus on procedure of dental billing and coding, which is useful for practices in finding ways to minimize mistakes and improve their method of revenue collection.
Here’s how we can assist:
Error-Free Billing
Our team makes a point of making all the claims we make accurate, comprehensively documented, and submitted well within the required deadlines to avoid denial of payment.
Denial Management
We study denied claims, address mistakes, and manage resubmission claims to boost revenues.
Insurance Coordination
From checking coverage to settling secondary claims, every process is covered on our end.
With The Medicator’s, you can concentrate on patients while we deal with all the nuances of dental billing.
Final Thoughts
Dental billing errors are potentially unprofitable, time-consuming, and damaging to the reputation of your practice. The following are the most frequent mistakes and some guidelines to help you get a healthy revenue cycle for billing.
Are you finally prepared to take your dental billing to the next level and reduce those errors? Give us a call at The Medicator’s today and we will gladly help you reduce the stress you get from handling your practice’s finances.
